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Breast fine-needle aspirates with scant cellularity are clinically useful
John T Vetto1, Rodney F Pommier, Richard L Shih
1Department of Surgery, Division of Surgical Oncology, L-223A, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. vettoj@ohsu.edu
American Journal of Surgery
|May 3, 2005
Summary
Scanty cellular fine-needle aspirates (FNAs) from breast lumps, when negative, are clinically useful and can help avoid unnecessary biopsies. Integrating these results with the triple test score (TTS) improves diagnostic accuracy.
Area of Science:
- Cytopathology
- Breast Imaging
- Oncology
Background:
- Current cytopathology standards deem fine-needle aspirates (FNAs) with scant cellularity inadequate.
- This study challenges this notion, hypothesizing that such aspirates hold clinical utility.
Purpose of the Study:
- To evaluate the clinical usefulness of scant cellularity FNAs in palpable breast lumps.
- To determine if negative scant cellularity FNAs can be safely interpreted within the context of the triple test.
Main Methods:
- A 10-year database of palpable breast lumps evaluated by FNA-based triple test (TT) was retrospectively analyzed.
- Scant cellularity FNAs without evidence of malignancy (negative SC-FNAs) were identified and correlated with subsequent cancer occurrence and triple test scores (TTSs).
Main Results:
- Out of 324 negative SC-FNAs, 9 subsequent cancers were detected.
- Seven of these cancers were associated with suspicious or malignant TTS (scores ≥5), indicating correct overall diagnosis.
- Two cancers were missed by both SC-FNA and TTS, resulting in a false-negative rate of 0.6% for the TTS.
Conclusions:
- Scanty cellular but negative FNAs are clinically useful in evaluating palpable breast masses.
- These FNAs can help avoid unnecessary invasive breast biopsies when interpreted alongside the TT and TTS.
- The triple test score provides a valuable contextual layer for interpreting scant cellularity FNA results.